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Under new health law, battles over who’ll do what

The bills focus on the relationship between primary-care doctors and nurse practitioners. | AP Photo

Hawkins noted that even as the health law expands access to health coverage with Medicaid, those patients could still be left without easy access to primary care. “It’s very difficult for a Medicaid recipient to find any provider willing to serve them,” he said.

Angela Golden, president of the American Association of Nurse Practitioners, noted that as many as 32 million uninsured Americans could gain coverage under the health law — and 55 million Americans live in areas that lack access to all the health resources they need.

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“You put those numbers together and that’s a pretty dramatic number for primary care. … We have got to find a way to serve all of those patients,” she said.

Filer of the AAFP said the solution is putting doctors at the head of a patient-centered medical home, overseeing nurse practitioners and other midlevel providers.

But Golden argued that forcing nurse practitioners to work under the supervision of a doctor would be “unsustainable” as demand for primary care ramps up under the federal health law.

Golden said that requiring doctors to oversee nurse practitioners’ care would limit their reach as the workforce grows over the next decade.

“When you regulate that, you put an additional barrier between the patient and the care … provided for them,” Golden said.

Hawkins of the National Association of Community Health Centers added that in medically underserved communities such as rural Alaska, doctors often need to move between multiple sites, necessitating nurse practitioners or physicians’ assistants to operate “independently.”

“It should not require on-site, physical supervision of that individual,” he said.

Former Health and Human Services Secretary Donna Shalala, who has stayed involved in health policy questions since becoming president of the University of Miami, argued that nurse practitioners and other health care professionals already operate under professional standards and don’t need added regulations requiring supervision.

“The reason that nurse practitioners are very wary of any regulatory framework for this is because there’s a professional framework for this,” said Shalala, who led an Institute of Medicine/Robert Wood Johnson Foundation study on the future of nursing.

Terie Norelli, speaker of the New Hampshire House of Representatives and president of the National Conference of State Legislatures, added that state lawmakers making decisions about these regulations need data — and the federal government should assist them in that effort.

But Hawkins countered that states need more than data — they need to change their mind-sets. “There’s a dichotomy in which the states that most need to grant broader authority to nonphysician providers are the same ones … that refuse to do so. That needs to change,” he said.